Purpose <p>To compare the short-term outcomes and the incidence of post-thoracotomy pain syndrome following dual- versus multi-portal robotic-assisted thoracic surgery.</p> Methods <p>We retrospectively analyzed a database of 287 patients from two institutions in Japan that perform dual- and multi-portal robotic-assisted thoracic surgery between September 2019 and August 2024. Patients underwent surgery for non-small cell lung cancer and were evaluated for short-term outcomes. Propensity score matching was performed to address differences in the patients’ background characteristics between the two surgical groups. Logistic regression analyses were performed to identify the risk factors for post-thoracotomy pain syndrome after robotic-assisted thoracotomy.</p> Results <p>Before matching and compared with the multi-portal group, the dual-portal group underwent fewer segmentectomies (<i>p</i> = 0.002) and had fewer dissected lymph nodes (<i>p</i> = 0.014). Patient’s characteristics were similar between the groups after matching. There was no significant difference in the short-term perioperative outcomes of both groups. The dual-portal group experienced a significantly lower rate of post-thoracotomy pain syndrome than the multi-portal group (<i>p</i> = 0.038). The predictive factors for post-thoracotomy pain syndrome in the multivariate analysis were multi-portal thoracic surgery and postoperative complications.</p> Conclusions <p>The short-term outcomes after dual- and multi-portal robotic-assisted thoracic surgery were comparable. However, multi-portal surgery was a predictive factor for post-thoracotomy pain syndrome.</p>